Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Cardiothorac Surg. 2022 Jun 15;62(1). doi: 10.1093/ejcts/ezab475.
Coronary artery disease is becoming a major health concern in the young population. Male and female patients may experience different journeys after coronary artery disease events. We aimed to evaluate risk factors and compare outcomes between young male and female patients undergoing coronary artery bypass graft surgery (CABG).
In this registry-based large sample size study, patients undergoing isolated CABG at a young age (premature isolated CABG) between 2007 and 2016 were included and followed up until 2020. Premature was defined as women and men younger than 55 years old. The main end points of the study were 7-year all-cause mortality and 7-year major adverse cardiovascular and cerebrovascular events (MACCEs).
Of a total of 24 428 patients who underwent CABG, 7217 patients (men-to-women ratio ≈4:1) with premature isolated CABG were included. The median follow-up duration was 78.5 months (75.2-81.6 months). The prevalence rates of diabetes mellitus, hypertension, dyslipidaemia and obesity were significantly higher in women than in men (58.3% vs 28.6%, 64.2% vs 38.5%, 69.7% vs 55.3% and 44.7 vs 23.9, respectively; all Ps < 0.05). The risk factor burden (mean of the risk factor count per year) was also higher among the female population. Diabetes mellitus was the common mortality predictor between men and women. In the subgroup analysis (interaction analysis in the adjusted model), hypertensive females had a higher rate of MACCE and a higher rate of mortality than hypertensive males; however, this difference was not significant in the non-hypertensive population. Opium addiction was a strong predictor of MACCE and all-cause mortality among men. Female patients had a higher rate of 7-year MACCE (hazard ratio, 1.33; 95% confidence interval, 1.16-1.51) and a higher rate of 7-year all-cause mortality (hazard ratio, 1.23; 95% confidence interval, 0.98-1.53).
The risk factor profile and predictors of outcomes were different between our female and male patients. Women carried a higher risk of events and mortality after CABG at a young age.
冠状动脉疾病在年轻人群中成为一个主要的健康关注点。男性和女性患者在发生冠状动脉疾病事件后可能会经历不同的历程。我们旨在评估风险因素，并比较接受冠状动脉旁路移植术（CABG）的年轻男性和女性患者的结局。
在这项基于注册的大样本量研究中，纳入了 2007 年至 2016 年间接受年轻（女性<55 岁，男性<55 岁）孤立性 CABG 的患者，并随访至 2020 年。主要终点为 7 年全因死亡率和 7 年主要不良心血管和脑血管事件（MACCE）。
在总共 24428 例接受 CABG 的患者中，纳入了 7217 例（男女比例约为 4:1）有过早孤立性 CABG 的患者。中位随访时间为 78.5 个月（75.2-81.6 个月）。女性的糖尿病、高血压、血脂异常和肥胖患病率明显高于男性（58.3%比 28.6%、64.2%比 38.5%、69.7%比 55.3%和 44.7%比 23.9%；均 P<0.05）。女性的风险因素负担（每年风险因素数的平均值）也更高。糖尿病是男性和女性共同的死亡预测因素。在亚组分析（调整模型中的交互分析）中，高血压女性的 MACCE 发生率和死亡率均高于高血压男性；然而，在非高血压人群中，这一差异无统计学意义。鸦片成瘾是男性 MACCE 和全因死亡率的强烈预测因素。女性患者 7 年 MACCE 发生率更高（危险比 1.33；95%置信区间 1.16-1.51），7 年全因死亡率更高（危险比 1.23；95%置信区间 0.98-1.53）。
我们的女性和男性患者的风险因素谱和结局预测因素不同。女性在年轻接受 CABG 后发生事件和死亡的风险更高。
